Operations Supervisor supervising donor flow and compliance in the plasma center. Maintaining the highest production standards and ensuring a clean and safe working environment.
AS
Hybrid Utilization Review Specialist – Substance Abuse Treatment Operations
Posted 5 months ago
About the role
- Utilization Review Specialist ensuring compliance in behavioral health treatment operations. Conducting authorizations and maintaining UR documentation for substance abuse programs.
Responsibilities
- Conduct and submit timely and accurate pre-certifications, concurrent reviews, and continued stay authorizations for clients across all levels of care (Detox, Residential, PHP, IOP).
- Proficiently utilize and document against established medical necessity criteria, including ASAM Criteria, LOCUS, and InterQual, to support clinical justification for treatment.
- Prepare and submit clear, clinically sound documentation for the initial stages of denial appeal and grievance processes.
- Maintain detailed and organized UR documentation within the Electronic Medical Record (EMR), ensuring all records are audit-ready and compliant with internal and external standards.
- Serve as a knowledgeable and professional point of contact for routine communications with payer representatives (insurance companies) regarding authorization requests and follow-up.
- Collaborate with the UR Manager and clinical team to ensure documentation supports full compliance with state licensing regulations (NJ DOH, FL DCF, CA DHCS) and accreditation standards (CARF/Joint Commission).
- Maintain current knowledge of relevant changes to payer guidelines, medical necessity criteria, and state/federal regulations that impact UR processes.
Requirements
- Bachelor’s degree in Healthcare Administration, Social Work, Nursing, Psychology, or a related field strongly preferred (or equivalent professional experience).
- Minimum of 2 years of proven, hands-on utilization review or case management experience in an inpatient behavioral health or SUD setting.
- Direct experience and proficiency in applying ASAM Criteria for patient placement and continued stay justification.
- Demonstrated ability to write clear, compelling clinical justifications for review submissions.
- Proficiency with Kipu EMR systems and general UR tracking/submission tools is highly preferred.
Benefits
- None specified
Job title
Job type
Experience level
Salary
Degree requirement
Tech skills
Location requirements
Operations Supervisor managing tasks within a plasma center and overseeing donor flow. Ensuring compliance with regulations and maintaining production standards in a healthcare company.
Legal Operations Analyst responsible for evaluating judicial processes and supporting the firm's legal strategies. Join Caixa Vida e Previdência, committed to assisting Brazilian families.
MOCC Coordinator managing care coordination within Indiana’s Medical Operations Coordination Center. Driving day - to - day implementation and collaboration among healthcare providers to enhance health outcomes.
Incident Operations Analyst at CCC, responsible for high - quality, timely incident communications across platforms. Engaging with teams to enhance status updates and communication workflows during incidents.
Senior Associate managing operations and project workstreams at Nuveen. Collaborating across teams to enhance business growth and operational efficiency in asset management.
Medical Science Liaison enhancing engagement with key medical experts in neuroscience. Fostering relationships and delivering medical insights for Biogen's therapies in a strategic role.
Regional Field Operations Manager leading operational success for 2 - 5 dental offices in New York Metro Area. Driving team performance and patient care while ensuring operational efficiency.
Cloud Platform Operations Analyst assisting in managing cloud platforms and automated solutions. Supporting networking and security tasks while collaborating with senior members on migration projects.
Sales Support Specialist entering contracts and managing documentation for sales processes. Collaborating with clients and teams to ensure efficient operations in the payments industry.